Disparities in Health Care: Issues for National Reporting (Text Version)

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On September 19, 2009, Kalahn Taylor-Clark made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (460 KB).

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Slide 1

Disparities in Health Care: Issues for National Reporting

Kalahn Taylor-Clark, PhD, MPH
Research Director, Racial/Ethnic Health Care Equity Initiative
The Brookings Institution

AHRQ 2009 Annual Conference
 

 

Slide 2

Overview

• Integrating equity in the data environment
• Overview of key IOM recommendations
• High Value Health Care Project/Equity Initiative
• Considerations for implementation of recommendations

 

Slide 3

Advancing Health Care Equity: Integrating the Data Environment

 

Slide 4

Institute of Medicine (IOM) Report
Key Recommendations
Subcommittee on Standardized Collection of Race/Ethnicity Data for
Healthcare Quality Improvement
August 31, 2009

Entities should collect data on granular ethnicity and elicit race responses consistent with current OMB standards

Collect data on preferred language and level of English proficiency

Develop standards to support data exchange of race/ethnicity/language across multiple entities

Utilize indirect estimation where self-reported data are unavailable
 

 

Slide 5

Racial/ethnic Health Care Equity Initiative Motivation and Goals
Motivation
Findings

• Consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable.

Recommendations

• Health care organizations should collect, report, and monitor patient-care data to build a foundation for solutions to racial/ethnic disparities in care
• Increase equity in care by increasing accountability and monitoring and improving clinical care quality

Challenges

• Despite continued attention to data concerns, inadequate information continues to limit the analyses of health care-related disparities and their outcomes.

Goals of Racial/ethnic Health Care Equity Initiative
Promulgate best practices for collecting, monitoring, and disclosure of race/ethnicity data to promote equity in care across all groups.
 

 

Slide 6

Massachusetts Quality and Cost Council Uniform Reporting System for Health Care Claims Data Sets 129 CMR 2.00

 

Race Code Code Description R1 American Indian/Alaska Native R2 Asian R3 Black/African American R4 Native Hawaiian or other Pacific Islander R5 White R9 Other Race UNKNOW Unknown/not specified

Ethnicity Code Code Description 2182-4 Cuban 2184-0 Dominican 2148-5 Mexican, Mexican American, Chicano 2180-8 Puerto Rican 2161-8 Salvadoran 2155-0 Central American (not otherwise specified) 2165-9 South American (not otherwise specified) 2060-2 African 2058-6 African American AMERCN American 2028-9 Asian 2029-7 Asian Indian BRAZIL Brazilian 2033-9 Cambodian CVERDN Cape Verdean CARIBI Caribbean Island2034-7 Chinese 2169-1 Columbian 2108-9 European 2036-2 Filipino 2157-6 Guatemalan 2071-9 Haitian 2158-4 Honduran 2039-6 Japanese 2040-4 Korean 2041-2 Laotian 2118-8 Middle Eastern PORTUG Portuguese RUSSIA Russian EASTEU Eastern European 2047-9 Vietnamese OTHER Other Ethnicity UNKNOW Unknown/not specified

 

 

Slide 7

Suggested Categories for Collecting RACE/LATINO ETHNICITY IDENTIFIER
(QCC)

• * Check All That Apply
• American Indian/Alaska Native
• Asian
• Black
• Hispanic/Latino/White
• Hispanic/Latino/Black
• Hispanic/Latino/Other
• Native Hawaiian/Pacific Islander
• White
• Declined

* If organization does not have space to collect more than one race/Latino ethnicity category, health plan may submit a waiver to include “multiracial” as a category.

 

Slide 8

LANGUAGE REPORTING

Top Ten Spoken Languages in Massachusetts by Census	Top Ten Most Frequently Encountered by MA Acute Care Hospitals	Top Ten Languages FLNE
Spanish	Spanish	Spanish
Portuguese	Portuguese	Portuguese
French	Russian	Chinese
Italian	Chinese	Haitian Creole
Chinese	Haitian Creole	Vietnamese
French Creole	Cape Verdean	Khmer
Russian	Vietnamese	Cape Verdean
Vietnamese	Arabic	Russian
Greek	American Sign Language (ASL)	Arabic
Polish	Albanian	Korean

*U.S. Census Report: http://www.fairus.org/site/PageNavigator/facts/state_data_MA
**FLNE - a bi-annual publication of MDPH with language data collected by the Massachusetts Department of Education for students whose primary language is not English.

 

 

Slide 9

Advancing Health Care Equity: Integrating the Data Environment

 

Slide 10

Considerations for
Developing Guidelines

• Consumer preferences. What are consumers' concerns about direct data collection by plans? What are consumer preferences for reporting race/ethnicity (e.g. available response categories)? To what messages about data collection activities/benefits do various consumer populations respond? What information on health care equity do consumers want to know?
• Modes of data collection. What are organizations' capabilities for acquiring directly collected or third party source data? What are cost effective modes of data collection for organizations?
• Use of data. How will organizations and State analyze data? What will (goals of) interventions be (i.e. quality advancement v. disparities reduction)? Who will be involved?

 

Slide 11

Considerations for
Developing Requirements

• Developing standard categories and thresholds for reporting
• Acquiring third party source data
  • Submission protocols/file formats
• Incorporating indirectly estimated data
  • Submission protocols/File formats
  • Incorporating directly collected and indirectly estimated data

 

Slide 12

Thank You!!

• ktclark@brookings.edu